Treatment for Strep Throat in Teenagers
Penicillin or amoxicillin for 10 days is the recommended first-line treatment for strep throat in teenagers. 1
Diagnosis
Before initiating treatment, proper diagnosis is essential:
- Use Centor Criteria to assess likelihood of Group A Streptococcal (GAS) pharyngitis
- Rapid Antigen Detection Tests (RADTs) should be performed in patients with high likelihood of streptococcal infection (3-4 Centor criteria)
- Clinical features alone are insufficient for diagnosis
First-Line Treatment Options
Penicillin V (First Choice)
- Dosage: 250 mg three times daily for 10 days 1
- Must complete full 10-day course to prevent acute rheumatic fever 2
- Advantages: Narrow spectrum, low cost, long history of efficacy
Amoxicillin (Alternative First Choice)
- Dosage: 50 mg/kg once daily (maximum 1000 mg) or 25 mg/kg twice daily (maximum 500 mg per dose) for 10 days 1, 3
- Particularly good option for teenagers due to better taste and twice-daily dosing improving compliance
- Complete 10-day course is essential 3
Important Treatment Considerations
- Treatment should continue for a minimum of 48-72 hours beyond symptom resolution 3
- A full 10-day course is required to prevent complications like acute rheumatic fever 1, 2
- Patients are considered non-contagious after 24 hours of effective antibiotic therapy 1
- Teenagers may return to school after 24 hours of appropriate antibiotic therapy if feeling well and fever has resolved 1
Alternative Options for Penicillin-Allergic Patients
- Azithromycin: 12 mg/kg once daily (max 500 mg) for 5 days 1
- Clindamycin: 300-450 mg orally three times daily for 10 days 1
Symptom Management
- Ibuprofen or acetaminophen for pain and fever relief 1
- Maintain adequate hydration 1
- Avoid aspirin in teenagers due to risk of Reye syndrome 1
Follow-Up Considerations
- If symptoms worsen or don't improve after 48-72 hours of antibiotic therapy, re-evaluation is needed 1
- Routine follow-up throat cultures are not indicated for asymptomatic patients who have completed appropriate therapy 1
- For recurrent strep throat, evaluate whether the patient is experiencing true recurrent infections or is a chronic carrier with viral infections 1
Potential Pitfalls
- Incomplete antibiotic courses may lead to treatment failure and complications 2
- Penicillin failure rates have increased over time, possibly due to poor compliance with 10-day regimens 4
- Twice-daily dosing of penicillin is as effective as more frequent dosing, but once-daily dosing is associated with decreased efficacy 5
- In areas with high clarithromycin resistance, 5-day clarithromycin regimens are not recommended 6
The evidence strongly supports a full 10-day course of either penicillin V or amoxicillin as the most effective treatment for strep throat in teenagers, with careful attention to completion of the full course to prevent complications and recurrence.